I’m here this morning speaking to you as a community
activist. As a community activist, I think it’s important that I tell you, or
perhaps just remind you, that the community needs the university. One only has
to think about the different changes that globalization, the dismantling of
social safety nets, the privatization of public services, the different and the
very dramatic changes that man-made and also natural disasters are having on our
communities, to begin to understand the many different kinds of questions that
the community desperately needs the university to address.

By the same token, I can say that the university needs the
community. Without the interest, the support, and the follow-through of the
community, all the research in the world will have little impact, and bring no
real answers or any real solutions. Ideas alone are meaningless without the
ability to see them through, and believe me, ideas that meet the real needs of
the community will be followed through.

This is why I’ve titled my talk today – Research with a
Pulse. I want to talk to you about the kind of research that makes a real
difference, research that will have a real effect on people’s lives, or at least
the kind of research that tries to. I am talking about research that will move
the public to care and to engage and research that will move politicians to act.

I used to think about research as being mainly about
statistics. I will confess to you right here and now that, I did get a D or
maybe it was a C- in my nursing statistics course. I have never really
considered myself a researcher, but I have done research, and fortunately my
first real-life research experience was a good one, it turned out to be research
with a pulse.

This first experience was the 1992 Street Health Report.
It was somewhat unique at the time, but in many ways it was just ‘classical’
community based research, and for me it was an extremely stimulating experience.
I will tell you a little bit about this report, our research, our findings and
some of the obstacles you could face in your own research. Then, I will give
you a bit of a ‘cook’s’ tour of some of the other research that I have been
involved in which was, let’s say, controversially successful.

The Street Health Report

I was pretty new to the issue of homelessness when I began
working at Street Health in 1989. It was an organization that was so close to
the street, to the issues, to the people, and it responded in very creative ways
to homeless people’s needs. In fact, it was a homeless man who first coined the
term “Street Nurse” as he hollered hello at us one day from across the street –
it was a sign of respect.

So, after a couple of years of street nursing, banging our
heads up against the walls of City Hall, provincial health card bureaucracies
and hospitals, we realized at Street Health that we had a responsibility to
better document both the health problems and the barriers to services – both
structural and attitudinal - that were encountered by the people we were
working with. So, we launched the Street Health survey, to be written by the 4
nurses who worked there, useful to the homeless community and their advocates
and reflective of homeless peoples’ experiences and their problems with the
health care system.

How we did it

From inception to the final report, the survey project took
over one year to complete. We formed a working group and partnered with the
Institute for Social Research at York University who guided us through the
process and the Toronto Public Health Department who provided data entry.

Key components of the work included:

-Development of a questionnaire that was both quantitative and qualitative
and which ultimately took 1.5 hours for each survey participant to complete

-Preparation, which included an inventory of 100 sites to develop a
sampling strategy, we had to create a definition of homeless, develop a
pre-survey, and a random selection process

-Hiring and training of 15 interviewers

-Scheduling to ensure 2 nurses were on site during all interviews to
handle health concerns or any crisis

-458 individuals were interviewed at 29 sites over a 6 week period
(December ’91 to January’92)

-Reimbursement of participants

What we found:

·Homeless men and women did not have different health problems than
the housed population but their conditions were made more difficult by poverty
and living circumstances. This was not rocket science but it was perhaps our
most important finding.

·Homeless people had 4x greater prevalence of emphysema and chronic
bronchitis;

·6x rate of epilepsy;

·5% had a brain injury (info that was offered unsolicited)

·40% had been assaulted at least once in the last year (essentially
half of all the women)

·25% of these assaults were by police = 10% of the entire sample

·21% of the women had been raped at least once in the past year

·8.5 % of the women had been physically or sexually assaulted
(including incest) in childhood (this response was also unsolicited)

·27% had considered suicide

·8% had attempted suicide in the last year

·40% did not have an Ontario Health Card

·25% had been provided treatment advice they were unable to carry
out

·The homeless were 2x as likely not to have received dental care in
the past year

These were pretty gruesome statistics.

What we did:

Data analysis and we determined what recommendations
flowed from the findings that would influence public policy.

Printing of a report that would be colourful and easily
read with sufficient copies for the community including homeless people.

We hosted a community briefing in City Hall Council
chambers followed by a press conference.

And finally, distribution of the Report to various
bodies (Board of Health, Ministry of Health, Police Services Board) and
vigorous follow-up with deputations, meetings and media work.

What we learned:

That change takes a long time.

That, as Michael Valpy says “nurses have the highest
believability quotient of all health care providers”. In fact, The World Health
Organization acknowledged the importance of the community-based nature of this
research.

And we learned, that when you offer criticism or
suggestions for improvement to just about any body, of course it’s not always
taken well, but there is usually some effort to address the questions. So, for
example, when we criticized community health centres for not taking into account
the needs of homeless people – that eventually changed. In fact, I went on to
become the first Nurse Practitioner employed full-time in a Nursing Outreach
Program that would specialize in homeless people’s health care needs in a CHC.

But, and there is a big but – should you ever
criticize members of the police, at least in Toronto, be prepared for what
happened to us. A special team of detectives were deployed to investigate the
Street Health Report, detectives that were sent out to “reportedly” find the
“bad apples” in the police force who were beating up on homeless people. They
did this by going to community agencies that were the sites for our interviews
and they asked staff if they knew any client that had partaken in our
survey. Furthermore, they demanded to see our raw data (which we obviously
refused). At the advice of our lawyers and our research consultants, our raw
data – 458 survey questionnaires, each about 30 pages long were put into
protective hiding – from the police.

Last month, nurses at Street Health had the following
experience. A man entered their office, suffering a head injury. He lapsed in
and out of consciousness. They called 911 immediately. They called again in 15
minutes. They made repeated calls. 45 minutes later an ambulance came. They have
lodged complaints with the various police and EMS bodies.

I can’t help but think there’s a link – despite the years
that have lapsed.

Housing is Health

Although the most sensational press coverage of the Street
Health Report was related to the findings on abuse, in reflection we helped to
prove the most obvious – that if you don’t have a home you are more unhealthy.
In my opinion there isn’t a lot more research needed on homelessness to make the
point that housing would go a long way to improve people’s health status.

There is now ample evidence on the connection between
housing and health but I would suggest that we have not used that evidence
adequately. When we call housing a ‘social determinant of health’ that phrase
sounds like academic lingo, it goes over the heads of most people. We need to
show, literally show, how housing improves health and that would be
research with a pulse.

I’d like to move from the Street Health Report and begin
what I’ll call a ‘cook’s tour’ of some other research initiatives I have worked
on.

The One Percent Solution and the Disaster
Declaration

I have to admit to being totally oblivious to the political
events in 1993 when the federal government cancelled its National Housing
Program – and I was a Street Nurse!

However, as conditions got worse, and we saw clusters of
deaths, the return of tuberculosis, malnutrition, mass outdoor sleeping, and the
horrible effects of crowding in shelters, the light bulb finally went on and I
joined with several

colleagues to form the Toronto Disaster Relief Committee.
In the summer of 1998 we wrote a report called the State of Emergency
Declaration which used statistics and referenced the UN Charters that Canada
had signed. It was a passionate document, at a very basic literacy level and it
was to the point.

Then, in October 1998 we held a press conference and
declared homelessness a National Disaster. What we saw was not unique to
Toronto. We believed that Toronto was the canary in the mineshaft of
homelessness in Canada. We released the State of Emergency Declaration (www.tdrc.net),
and we called for two things:

First, that federal emergency relief monies be
released to communities across the country so they could provide disaster relief
for their rapidly growing homeless populations. This effort is not unlike what
is happening within the United States in the wake of Hurricane Katrina;

Second, we called for a long term solution, the 1%
solution – a National Housing Program where all levels of government would spend
an additional 1% of their budgets to build affordable housing. The One Per Cent
Solution originates from research done by Professor David Hulchanski, who
determined that when our federal, provincial, territorial and municipal
governments were allocating money to social housing they were spending on
average 1% of their budgets.

So, here’s the pulse:

The first item essentially occurred. Homelessness in Canada
was catapulted on the national and international scene. Prime Minister Chretien
appointed Claudette Bradshaw as our first ever Minister Responsible for
Homelessness and ‘SCPI’ (Supporting Community Partnerships Initiatives)
monies were rolled out across the country. So, Canada had the distinction of
having a Minister Responsible for Homelessness but not a Minister with full
responsibility for housing! The hundreds of millions of SCPI dollars were, in
effect disaster relief monies.

Regarding the second point – we are now very close,
especially with the Layton-Martin budget deal that includes $1.6 billion for
housing and Minister Fontana is poised to release Canada’s first Housing
Framework document which could lead, finally, to a national programme.

The importance of historical research

We can always learn from our history whether it is 10 years
ago or fifty. We refer to history a lot. So, we often remind people what it was
like when we had no national housing program.

In 1947 Toronto Mayor Saunders took out an ad in a Toronto
newspaper warning people not to come to Toronto. Why was that? We had no
national housing programme.

In our history we once had a national programme and it
created thousands of units per year. There are ways we can show that. In every
community those homes are there.

The Disaster

I know that people across the country had great hopes for
the 1999 Ann Golden Report Taking Responsibility for Homelessness also
known as the Mayor’s (Lastman) Homelessness Action Task Force. The Report is 1”
thick and had 105 recommendations. Today, 6 years later, the report’s first
recommendation, that the City “appoint a Facilitator for Action on Homelessness
for a five-year term, who will report to the Mayor and Council” was never
implemented. Needless to say, many other Task Force recommendations, such as
the construction of 5,000 additional supportive housing units over a 5 year
period, did not materialize.

Conditions have worsened. We have seen an increasing
reliance on emergency shelters, we have seen disease outbreaks and infestations,
we have seen a climbing death toll, and the development of more outdoor
encampments by people who want to avoid a clearly unhealthy shelter system.

So, when more traditional methods of advocacy such as
deputations, press conferences, inquests, even touring the Medical Officer of
Health to shelter sites did not bring in the changes we needed to respond to
this crisis, we began to employ more unorthodox research techniques.

Secret Video Footage

It was actually film maker Shelley Saywell, who while
working on a film about homelessness, called Street Nurse, first captured the
shelter conditions in Toronto that violated the United Nations standard for
refugee camps. Unbeknownst to me the footage was taken and when I was shown the
footage – the horror.

Over 100 men and women – people sleeping on the floor

lights kept on all night because bodies were so close
together

a stagnant and airless basement

4 people in the space that one person should have,
according to the UN

It was clear we had to do something with this footage. If
there had been a fire and we had stayed silent we would have been responsible.

The pulse: We used it, respecting privacy issues,
and within a month this facility was given assistance to improve its conditions.

Later that year when it was apparent the City would not
extend its remediation of shelter conditions beyond this one single case, we
rented our own secret camera from Spyshop and took to the streets and to the
shelters again. This footage showed line-ups reminiscent of the depression era,
and inhumane images of emergency shelter conditions that did not meet the UN
standards. As Dri from Tent City said “if people saw animals kept in these
conditions – they would be so upset.”

The Shelter Inspection Report

In June 1999, shelter capacity in Toronto had exceeded 90%.
City Council passed a motion directing staff to open additional shelters
whenever shelters reached the 90% capacity. It never occurred.

In June 2000, TDRC first called upon Toronto’s Medical
Officer of Health to carry out a special investigation of health standards in
the shelter system to ensure they met international public health standards.
No such inspection was done.

In 2001, TDRC took the Medical Officer of Health on a tour
of the shelter conditions. No changes were made.

In 2001, Toronto had its first tuberculosis outbreak.
Three homeless men died.

In January 2003, TDRC formally requested that the City’s
Shelter Housing and Support Division assemble a team of independent experts who
would enter the hostel system to investigate shelter conditions. We received
no reply.

So these events and many more led us to create our own
Shelter Inspection Team that heard evidence from homeless people. In addition,
several homeless people were equipped with a checklist to survey some shelters.
For example, using a piece of rope they measured space between beds/mats, they
looked at fire exits, the number of showers, the number of working toilets, etc.

The Shelter Inspection Report is simple and to the
point. It is available on our web site
www.tdrc.net.

Now, to the pulse of this research: the City’s
Shelter Standards now reference some of the United Nations standards for space
and SCPI monies have been used to upgrade the conditions in many Toronto
shelters. As my colleague Michael Shapcott says “homeless people were made more
comfortable by the SCPI money but no less homeless.” A reminder why we need to
keep up the pressure for housing money.

I should note that in May 2003 when the Shelter Inspection
Report was released, Toronto was facing its first Severe Acute Respiratory
Syndrome (SARS) outbreak. SARS is a deadly reminder of the life and death
situation that face people forced to live in congregate living situations.

Plagues

I use some literary license when I talk about plagues, but
tuberculosis is historically known as the ‘white plague’.

In many cultures there are legends about pestilence. In
Russia it was the Pest Maiden who carried disease throughout villages causing
peasants to fall dead before her. After a visit from the Pest Maiden, funeral
processions clogged the streets. Occasionally a peasant would fight the Pest
Maiden off and she would go into the forest to wait for another day and another
opportunity to attack.

Andrew Nikiforuk uses imagery like this in his book The
Fourth Horseman to describe the cyclical nature of plagues, scourges and
emerging viruses that erupt when social disasters like overcrowding, hunger and
homelessness devastate a country. He describes the Fourth Horseman as one of the
riders of the Apocalypse, who is both pestilence and death, riding into our
lives with epidemics, pandemics and death.

Bedbugs, Tuberculosis, West Nile, Norwalk, SARS, Pandemic
flu. These are today’s scourges that require more research. Why? To prove that
congregate living is deadly and housing is the solution!

In 2003 we once again entered the area of community
research by holding an inquiry into TB where we heard primarily qualitative
evidence on the issue.

The pulse - it led to an inquest and it led to many
community and hospital sector workers being very adequately prepared on the
issue to provide expert testimony at the subsequent Inquest. Our report is
called TB or not TB? and is available on
www.tdrc.net

Death on the Streets of Canada

In 1999, University of Toronto Professor David Hulchanski
prepared a document called Death on the Streets of Canada. It was
presented to the United Nations Human Rights Committee. It pointed out that
Canadian government inaction was leading to a dramatic increase in morbidity and
death.

The pulse – it led to comments of concern by the UN
Committee and again placed the issue on the international agenda.

Today, we continue to track homeless deaths, adding 8-10
names per month to the Homeless Memorial board at our monthly vigil in Toronto.
To date, no government body is responsible for tracking homeless deaths.

Two weeks ago, a 59 year old homeless man by the name of
Paul Croutch was brutally beaten while in his sleeping bag sleeping in a park
adjacent to the federal Moss Park Armouries in Toronto. Three army reservists
have been charged with second degree murder. We are calling for this crime to be
considered a hate crime. It’s not the first time we have seen homeless people
murdered in Canada. But it should be the last.

Once again, we in the community are desperately seeking
research support on this issue.

Can Research be the Solution?

I’m inclined to say it can be part of the solution.

I’d like to give you three examples.

1) The Tent City Story

From tents to shacks with woodstoves, insulation to pre-fab
housing – these were some of the methods used to help support and transform a
community. I can’t say that we did research on these substantive changes to
people’s living conditions at Tent City but it would have been possible.

But there were three pieces of research that did happen.

The first - the Tent City Census. At one point Tent
City was growing so rapidly we did a census of our own to track the numbers and
we distributed shower bags in the process as a gift for participating. It was a
good thing we did – only a month or two later the forced eviction happened and
we were able to say that Tent City consisted of 120 people, 14 dogs, 50 shacks,
etc – and we used that data to fight for their housing. And we won.

The Second – the pre-fabs. By bringing in pre-fab
housing for anywhere between $1,000 to $10,000 per unit we were able to show
that people would choose to live in such a dwelling instead of in a tent, on the
street or in a shelter. The cost of keeping someone in a shelter per month:
between $1140 - $2100 per month compared to zero at Tent City, once the housing
was provided.

The Third - and perhaps the most important research on
Tent City - the Rent Supplement Win.

Cost: $11,631 pp per annum (including their social
assistance) compared to $16,156 pp per annum to keep someone in a shelter

80% are eating better

93% stress the importance of their housing support
worker

In this case terrific research was done by the City of
Toronto that adds to the point that housing is health. This report is
also available at www.tdrc.net

2) Hunger and Malnutrition

Even when people become housed, we know they remain hungry.
Important work is now underway by OCAP (the Ontario Coalition Against Poverty).
Their campaign around the special diet allowance available in Ontario for people
on social assistance has now put more than 4,000 people in a more adequate
position to afford food. In organized “diet clinics” around Toronto and southern
Ontario, health providers are assessing people for this $250 allowance. An
example of the impact: a family of 6 on social assistance receives an additional
$1500 per month once the diet forms are completed by a licensed health
practitioner.

At the same time doctors at St. Michael’s Hospital are
using the opportunity to research people’s food intake prior to receiving the
dietary allowance.

As of August, 8,353 Toronto welfare recipients were
receiving the $250 monthly special diet allowance – an increase of at least 30%.

3) Report Cards

TDRC is the secretariat for the National Housing and
Homelessness Network. We regularly issue Report Cards – on how the federal
government is doing province by province and in the territories, on their
promises to fund and build housing. In fact, politicians have become very
sensitive about our Report Card, often questioning their B-, C or D, hoping to
get a higher grade I guess.

Sometimes it’s as simple as number crunching to get the
attention of politicians.

In conclusion, where are we today?

Well, we’ve researched homelessness to death, literally.

We still do not have a “coherent policy of national
standards to ensure that the right to adequate housing is enjoyed by all and
particularly by poor and disadvantaged groups, such as low-income women.”
(Canadian NGOs submission to the UN Committee on Economic and Cultural Rights
Working Group, May 16, 2005).

We have a predicted federal surplus of maybe $10 billion
dollars. Hopefully $1.6 billion of that will fulfill the housing portion of the
Layton-Martin budget.

We have some provincial governments still refusing to
release promised dollars for housing. For example, in Ontario, 63 units were
developed in the first 3 years of the federal-provincial Ontario program. They
should have created 8,592. In late August, the province finally announced how
they would begin allocating those monies however analysis shows that units
created will be heavily weighted towards home ownership. This was Ontario’s 11th
announcement (reannouncement) and report of allocations since 2001.
Announcements and allocations on paper do not always translate into affordable
housing starts.

But, we are stronger and more sophisticated in our lobbying
efforts than ever before. Our challenge is to get the research that supports our
efforts – whether it is in the area of child care, nutrition, poverty or
homelessness.

In four days the federal-provincial-territorial housing
ministers will be meeting in Nova Scotia. We will be there! We have a tradition
of building a house, a straw-bale house, a house of blocks, to show them what
they should be doing.

In closing, I want to leave you with these questions.

Can research help to house our people?

Can research help to feed hungry families?

Can research prevent the catastrophic assault of the
approaching pandemic flu?

Can research quantify the extent of injury of various
social policies – like workfare or reduced employment insurance benefits, or
delisting of services?

Or quantify the benefits of universal child care, public
access to health care, expanded home care programs?

Can universities and communities collaborate so that
research can be a tool to help recharge activism? The Dalai Lama speaks of
meditation as a form of recharging – so one can then move to implement ideas
into action. I think the same could be said for research, that it can provide
the fuel, the energy, the pulse if you will for action, for social change.